Workers’ Compensation Fraud Case Highlights Value of Investigators


This week, a Scarborough man was sentenced in federal court  to five months in prison followed by five months of home confinement for concealing self-employment income while receiving federal wage-replacement workers’ compensation benefits.  The man, a former United States Post Office driver, had been collecting weekly benefits since 2001, was required to file annual forms certifying that he was not working.  In 2012 an undercover agent  caught him operating a long-haul car transportation business on a cash-only basis.

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AMA Protocol for Evaluating Injury-Relatedness and Work-Relatedness


In the civil litigation and workers’ compensation fields, medical experts are often called on to give opinions about whether a particular medical condition was caused or contributed to by a specific injurious event or by the conditions of the claimant’s employment.  Often these questions are directed at doctors whose daily practice involves primarily diagnosis and treatment, and not determining a medical causal relationship between medical conditions and events.  As a result, when faced with these issues, some doctors resort to assessing causation on a purely subjective basis: i.e. the patient’s self report.  Fortunately, the American Medical Association’s Guides to the Evaluation of Disease and Injury Causation provide evaluators with a protocol for making scientifically credible findings on causation.

The Protocol provided by the Guides is a six-step process.  Failure to complete any of the steps in a manner that supports a causal relationship eliminates credibility for claims of injury-relatedness or work-relatedness.  The six steps are:

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The Recorded Statement: An Invaluable Resource


Research has shown that human memory deteriorates over time.  The more time passes between the moment a memory is made and the time it needs to be remembered, the less accurate recall is likely to be.  Unfortunately for defense lawyers, by the time a file appears on our desk, months if not years have likely passed since the event that gave rise to the claim.  By the time we have a chance to interview witnesses or ask the plaintiff questions under oath, the answer “I can’t recall” becomes all too common.

Fortunately, there is a solution to this problem: Continue reading